Effects of the COVID‐19 pandemic and lockdown on symptom control in preschool children with recurrent wheezing

Abstract

Introduction Preschool wheezers are at high risk of recurrent attacks triggered by respiratory viruses, sometimes exacerbated by exposure to allergens and pollution. Because of the COVID‐19 infection, the lockdown was introduced, but the effects on preschool wheezers are unknown. We hypothesized that there would be an improvement in outcomes during the lockdown, and these would be lost when the lockdown was eased. Materials and Methods Patients underwent medical visits before and after the COVID‐19 lockdown. We recorded the childhood Asthma Control Test (cACT) and a clinical questionnaire. Data on symptoms, the need for medications and the use of healthcare resources were recorded. We compared these data with retrospective reports from the preceding year and prospectively acquired questionnaires after lockdown. Results We studied 85 preschool wheezers, mean age 4.9 years. During the lockdown, cACT score was significantly higher (median 25 vs. 23); families reported a dramatic drop in wheezing episodes (51 vs. none), significant reductions in the day and nighttime symptoms, including episodes of shortness of breath (p < .0001); the use of salbutamol and oral corticosteroids (OCS) dropped significantly (p < .0001) and 79 (95%) patients needed no OCS bursts during the lockdown. Finally, patients had significantly fewer extra medical examinations, as well as fewer Emergency Room visits (p < .0001). All were improved compared with the same time period from the previous year, but outcomes worsened significantly again after lockdown (cACT median: 22). Conclusions During the national lockdown, children with persistent preschool wheeze showed a significant clinical improvement with reduction of respiratory symptoms, medication use for exacerbations, and use of healthcare resources. This trend reversed when lockdown restrictions were eased.

Improvement in Asthma Symptoms and Pulmonary Function in Children After SARS-CoV-2 Outbreak

“…Asthma symptom control was more frequently achieved during the only studied quarter (Q4-2020) which included a period of lockdown for non-essential workers and for middle and high schools. This is concordant with a study in which asthma control scores from 85 children increased during the lockdown (9).…”

“…Though this study focuses on LFT results, it would be interesting to compare the trends of exacerbations in asthmatic patients to the number of hospital admission during this period. A recent study showed that hospital admissions for asthma were significantly lower during lockdown, suggesting a reduction not only of mild, but also of severe exacerbations (9).…”

Letter from Spain

“…We also observed that, according to a validated questionnaire to assess asthma control in paediatrics, 4 most of them (87.7%) maintained good asthma control during isolation. As with similar recently published findings, 5 the high rates of well-controlled asthma observed could be related to different reasons: better therapeutic adherence, lower circulation of respiratory viruses (mainly rhinovirus) because of lockdown measures and improvement in air quality.…”

The impact of the COVID‐19 pandemic on respiratory morbidity during infancy: A birth‐cohort study

“…However, these reports are related to different populations of children and employed a different methodology. Nicola Ullmann et al 15 reported similar results regarding decreased wheezing episodes, recurrent wheezing (>3 episodes), bronchodilators, systemic steroid use, and ER admissions. However, this study refers to children 2–5.9 years old with a history of recurrent wheezing.…”

“…Three lockdowns and strict restrictions led to a dramatic reduction in health care utilization and presentations to the emergency room (ER) among children of all age groups. [15][16][17][18][19][20][21][22][23][24][25] Observing the COVID-19 restrictions, increases hygiene and decreases exposure to other infectious agents. In addition, lockdowns have the potential to reduce exposure to wheezing triggers such as viral infections, environmental pollution, exercise, and smoke.…”